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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diarrhea (0/7, HIV+), and 0/20 control children. Among children with acute diarrhea, 7/7 with cryptosporidiosis were malnourished, compared with 10/48 without cryptosporidiosis (P < .01). Enterocytozoon was identified in specimens from 3/86 adults, 2/59 children with chronic diarrhea (1 HIV+), 0/55 children with acute diarrhea, and 4/20 control children. All four controls were underweight (P < .01). Cyclospora was identified in specimens from one adult and one child with acute diarrhea (HIV-). Thus, Cryptosporidium was the most frequent and Cyclospora the least frequent pathogen identified. Cryptosporidium and Enterocytozoon were associated with malnutrition. Asymptomatic fecal shedding of Enterocytozoon in otherwise healthy, HIV children has not been described previously.
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PMID:Cryptosporidium, enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania. 1006 50

To investigate the role of Helicobacter pylori in childhood diarrhoea, specific IgG antibodies to H. pylori (determined by an ELISA) were sought in 119 infants aged 3-36 months in Peru. Thirty one of the infants had acute diarrhoea (defined as lasting < 72 h and not present in the previous 3 weeks), 67 had persistent diarrhoea (lasting > or = 14 days with no more than 1 intervening diarrhoea-free day) and the remaining 21 had not had diarrhoea in the previous 3 weeks. The children with diarrhoea had been admitted to hospital in Lima for diarrhoea treatment, and the diarrhoea-free children for investigation of possible tuberculosis. Aspirates of duodenal contents and duplicate stool samples were investigated for the presence of bacterial overgrowth and of pathogenic bacteria, viruses and parasites. Anthropometric measurements were also made. There were no statistically significant differences between the prevalence rates of IgG against H. pylori in the children with acute diarrhoea, persistent diarrhoea and without diarrhoea (32%, 43% and 29%, respectively). In addition, H. pylori infection (as evidenced by specific antibodies) had no apparent influence on the presence of small-bowel overgrowth (in 20% of seropositive children compared with 18% of seronegative children) or of pathogens in the stool (in 53% of seropositive children compared with 49% of seronegative children) or on the occurrence of malnutrition in the groups of children considered as a whole. We conclude that H. pylori infection is not associated with acute or persistent diarrhoeal disease, small-bowel overgrowth, stool pathogens or malnutrition in Peruvian children.
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PMID:Helicobacter pylori is not a determinant factor of persistent diarrhoea or malnutrition in Peruvian children. 1069 16

Diarrhoea continues to have a devastating impact in infants and children. It is a major cause of retarded growth. Substantial declines in hospitalization rates and possibly in the mortality due to diarrhoea have occurred following the launch of programmes based on oral rehydration therapy, and yet about 1 million diarrhoea-related deaths occur each year in South-East Asia. The World Health Organization currently recommends oral rehydration therapy plus continued breast- and complementary feeding for children with diarrhoea, and antibiotics for dysentery or associated systemic infection. Although oral rehydration therapy has achieved substantial acceptance, physicians and families continue to prescribe and seek drug therapy to reduce diarrhoeal duration and severity. Research is aimed at developing improved oral rehydration salt solutions or identifying adjunct therapy that will provide substantial benefit in reducing stool output together with safety and selectivity of action. It must, however, be recognized that control of malnutrition is a key requirement to reduce the duration and severity of acute diarrhoea.
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PMID:Current and future management of childhood diarrhoea. 1071 4

With worldwide use of oral rehydration solutions, the treatment of acute diarrhea does not pose much of a problem. However, chronic diarrhea is still harmful, especially for the growth and development status of the children. Between January 1993 to December 1996, patients who suffered from chronic diarrhea for more than one month duration and admitted to Dr. Sami Ulus Children's Hospital were evaluated for epidemiological and etiologic factors. Seventy consecutive patients were evaluated. The mean age was 40.8 months and 52% were males. Malnutrition was detected in 80% of cases. Etiologic factors included celiac disease 30%, cow milk allergy 17%, bacterial and parasitic factors 26%, cystic fibrosis 10% and postinfectious gastroenteritis 10%. Eosinophilic gastroenteritis, chronic nonspecific diarrhea, pseudo-obstruction, neurofibromatosis and inflammatory bowel disease were rarely detected. Celiac disease and cow milk allergy were implicated as the most common causes of chronic diarrhea. The vicious cycle of faulty nutrition, malnutrition and infection and postinfectious enteropathy were also significant factors in the etiology of chronic diarrhea. It may be considered that cow milk protein prick test, sweat test, immunologic tests and mucosal biopsies should be performed for the definite diagnosis of chronic diarrhea.
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PMID:Etiology of chronic diarrhea. 1079 25

Role of micronutrients namely vitamin A, zinc and folate, as adjunct therapy of illness episodes in children in developing countries have been discussed in the light of health policy. Apart from a selective review, attempts have been made to statistically combine results of several studies to address policy issues. In children, vitamin A supplementation during illness has (a) a profound effect in reducing mortality in measles, (b) possibly a significant effect in reducing persistent diarrhea episodes in children with acute diarrhea, and (c) no benefit in pneumonia. Use of large dose vitamin A is recommended during measles episodes but not in non-measles pneumonia. Its use in acute diarrhea is debatable but recommended in persistent diarrhea and in severe malnutrition as a component of a micronutrient mixture. Large dose vitamin A supplementation should be used with caution in young infants as there are unresolved concerns about its safety particularly, bulging fontanelle observed in infants when co-administered at immunization. In children, zinc supplementation during illness, (a) had a marked effect in reducing prolonged episodes and a modest effect on episode duration in acute diarrhea, (b) resulted in reduced rate of treatment failure and death in persistent diarrhea, (c) had no effect in measles and non-measles pneumonia, and (d) probably had a detrimental effect of increasing death rate when a large dose was used in severely malnourished children. The desirability of routine zinc supplementation therapy of undernourished children with acute diarrhea should be assessed further. Concerning policy, zinc supplementation as a component of a micronutrient mixture is recommended in the rehabilitation of severely malnourished children and in persistent diarrhea. However, recommendation for its routine use in all cases of acute diarrhea in children needs additional studies on effectiveness, cost, operations and safety. In two randomized controlled trials folate has been evaluated in acute and persistent diarrhea and found to have no beneficial effect. Folate is not recommended as adjunct therapy of diarrhea. Role of folate in preventing severe disease and/or death deserves further evaluation.
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PMID:Micronutrients as adjunct therapy of acute illness in children: impact on the episode outcome and policy implications of current findings. 1150 4

Malnutrition increases morbidity and mortality and affects physical growth and development, some of these effects resulting from specific micronutrient deficiencies. While public health efforts must be targeted to improve dietary intakes in children through breast feeding and appropriate complementary feeding, there is a need for additional measures to increase the intake of certain micronutrients. Food-based approaches are regarded as the long-term strategy for improving nutrition, but for certain micronutrients, supplementation, be it to the general population or to high risk groups or as an adjunct to treatment must also be considered. Our understanding of the prevalence and consequences of iron, vitamin A and iodine deficiency in children and pregnant women has advanced considerably while there is still a need to generate more knowledge pertaining to many other micronutrients, including zinc, selenium and many of the B-vitamins. For iron and vitamin A, the challenge is to improve the delivery to target populations. For disease prevention and growth promotion, the need to deliver safe but effective amounts of micronutrients such as zinc to children and women of fertile age can be determined only after data on deficiency prevalence becomes available and the studies on mortality reduction following supplementation are completed. Individual or multiple micronutrients must be used as an adjunct to treatment of common infectious diseases and malnutrition only if the gains are substantial and the safety window sufficiently wide. The available data for zinc are promising with regard to the prevention of diarrhea and pneumonia. It should be emphasized that there must be no displacement of important treatment such as ORS in acute diarrhea by adjunct therapy such as zinc. Credible policy making requires description of not only the clinical effects but also the underlying biological mechanisms. As findings of experimental studies are not always feasible to extrapolate to humans, the biology of deficiency as well as excess of micronutrients in humans must continue to be investigated with vigour.
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PMID:Micronutrient deficiency in children. 1150 11

Increased concentrations of reactive oxygen species (ROS) and depleted antioxidant defences have been implicated in a cycle of infection, malabsorption and malnutrition, leading to persistent diarrhea. In order to determine whether in non-malnourished children oxidative stress predisposes to the development of persistent diarrhea, infants with acute diarrhea (< 7 days) (n = 39) were compared to infants with persistent diarrhea (> 14 days) (n = 38). Lipid peroxidation was assessed by the TBARs assay and expressed as malondialdehyde equivalent content (nmol MDA/ml plasma), and levels of plasma antioxidants vitamin A and vitamin E were determined. In infants with acute and persistent diarrhea nutritional status, as assessed by weight/height and height-for-age, hemoglobin levels, serum albumin and immunoglobulin levels, did not differ between groups. Serum vitamin A and vitamin E levels did not differ in infants with acute or persistent diarrhea. TBARs, expressed as nmol MDA/ml plasma did not differ between infants with acute or persistent diarrhea and furthermore did not differ from levels in a healthy, similar age, control group. Non-malnourished infants with persistent diarrhea do not exhibit plasma antioxidant depletion or enhanced lipid peroxidation. In these infants, oxidative stress, as reflected in plasma, does not play a role in the pathogenesis of persistent diarrhea.
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PMID:Oxidative stress is not enhanced in non-malnourished infants with persistent diarrhea. 1169 27

Dr. Ayesha Molla, an ICDDR,B biochemist-nutritionist, was awarded a gold medal by the Bangladesh Women Scientists' Association and named Best Woman Scientist of the Year. She was honored for outstanding achievements in diarrhea/nutrition research especially in her classic studies on nutrient absorption during diarrhea. Her recent work has focused on the diarrhea/malnutrition mechanism in children. Her findings indicate that eating during acute diarrhea should be encouraged to reduce post-diarrhea malnutriton in vulnerable developing country children. In another study in collaboration with her husband, a pediatrician and gastroenterologist, it was found that diarrhea has a negligible effect on secretion of digestive enzymes which partially explains why significant digestion and absorption continue during diarrhea. Dr. Molla was also honored for related studies on the vitamin A/diarrhea/malnutrition mechanism. This is of immense importance in developing countries since repeated diarrheal infections in children aggravate malnutrition and lead to vitamin A deficiency blindness. Most blindness seems to be associated with or preceded by recurrent diarrheal infections. Dr. Molla found that water-soluble vitamin A administrated orally was associated with rapid improvement of deteriorating eye conditions. A brief outline of her background is given and her current work discussed. She is presently involved in seeking the best possible diet for children suffering from severe protein energy malnutrition (PEM). This problem results in coincident lack of varying proportions of protein and energy. Dr. Molla is attempting to determine the fastest, most tolerable, low cost, readily available and culturally acceptable diet. Maternal training in feeding practices will be provided. In collaboration with her husband, Dr. Molla is also studying the 2nd generation Oral Rehydration Solution (ORS). They are working to substitute rice or other staples for the traditional sugar in ORS.
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PMID:Bangladesh women scientists' association honours ICDDR,B scientist. 1227 28

Mortality from diarrheal diseases is most common in areas with high prevalence of caloric malnutrition. The considerable reduction of mortality from diarrhea following introduction of oral rehydration therapy has revealed the seriousness of persistent diarrhea with malnutrition. Persistent diarrhea is internationally defined as a diarrheal episode lasting 14 days or longer, generally accompanied by growth problems and protein calorie malnutrition. Persistent diarrhea is now considered a nutritional disease, generally occurring in low birth weight or malnourished children and itself a significant cause of protein calorie malnutrition. 10% of episodes of acute diarrhea are believed to evolve into persistent diarrhea, which accounts for 35% of deaths from diarrhea. Around 15% of episodes of persistent diarrhea are fatal. Several risk factors have been identified. Most patients are under one year old. Various studies have shown that protein calorie malnutrition retards repair of the damaged intestinal epithelium and prolongs diarrhea. Recent introduction of milk of animal origin is implicated in 30-40% of episodes of persistent diarrhea. Patients at risk have been shown to react abnormally to skin tests of antigens and to have recent histories of acute diarrhea or previous episodes of persistent diarrhea. Inconclusive studies implicate antimotilic drugs such as paregoric elixir and indiscriminate use of antibiotics as risk factors, but increased risk has been proven only with some antiparasitics. Patients with persistent diarrhea are deficient in vitamins A, B12, and folic acid, and in zinc and iron. Children under 6 months of age with persistent diarrhea should be hospitalized. Adequate feeding is the most important aspect of treatment. The objectives of nutritional treatment include temporary reduction of milk of animal origin, assurance of sufficient protein and calorie consumption, avoidance of foods aggravating the diarrhea, and correction of existing malnutrition.
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PMID:[Persistent diarrhea]. 1229 May 53

Persistent diarrhea (PD) is 3 or more stools/day which lasts nonstop for 14 days. Some small intestine disorders impede its diagnosis. PD follows 3-20% of acute diarrhea cases. It is more difficult to treat than acute diarrhea and often brings about nutritional and metabolic complications, e.g., growth failure. Skin infection, systemic infection, and micronutrient deficiency often accompany PD so it is often referred to PD syndrome (PDS). PDS patients often have more frequent recurrences of diarrhea although not of PD. Deaths of hospitalized PDS patients range from 10-12% and most occur within the 1st 48 hours. Physicians should immediately follow the guidelines for managing sepsis dehydration, fever, hypoglycemia, and malnutrition when 1st treating a hospitalized PDS patient. They should then start broad spectrum antibiotics. Once stable, nutrition management can begin. This includes maintaining breast feeding or using expressed breast milk, a digestible balanced diet free of allergenic proteins, and additional micronutrients and vitamins. Upon arrival at home, the child should eat a high energy high protein diet. PDS most often occurs in young infants, e.g., peaking at 7 months in Bangladesh. Other risk factors include nonbreast feeding, recent antibiotic therapy, history of bloody diarrhea, vitamin A deficiency, and malnutrition. Giardia lamblia and aggregative, enterotoxigenic Escherichia coli in the stool have been associated with PDS, but have not yet been identified as causative agents. Scientists surmise that PDS is caused by an insult to the intestine which allows the passage of proteins, especially dietary proteins, through the mucosa thereby inducing a hypersensitive reaction which causes more mucosal damage. Excess bacterial growth plays a role in production of an irritant product which contributes to fluid loss.
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PMID:Persistent diarrhoea syndrome. 1231 13


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